Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease

Abstract

We performed a cross-sectional study of newly diagnosed cases of nonalcoholic fatty liver disease (NAFLD) identified between December 1998 and December 2000 in the Chronic Liver Disease Surveillance Study. We compared the demographic and clinical features of NAFLD in a racially diverse representative U.S. population (Alameda County, CA). Diagnostic criteria for probable NAFLD were persistent unexplained elevation of serum aminotransferase levels, radiology (ultrasound or computed tomography scan) consistent with fatty liver, and/or two or more of the following: (i) body mass index of 28 kg/m 2 or more, (ii) type 2 diabetes, or (iii) hyperlipidemia, in the absence of significant alcohol use. Definite NAFLD cases required histological confirmation. Of the 742 persons with newly diagnosed chronic liver disease, 159 (21.4%) had definite or probable NAFLD. The majority were nonwhite: Hispanics (28%), Asians (18%), African Americans (3%), and other race(s) (6%). African Americans with NAFLD were significantly older than other racial or ethnic groups (P < .001), and in Asians, NAFLD was 3.5 times more common in males than in females (P ‫؍‬ .016). Clinical correlates of NAFLD (obesity, hyperlipidemia, diabetes) were similar among racial and ethnic groups, except that body mass index was lower in Asians compared with other groups (P < .001). Compared with the base population (Kaiser Permanente members), Hispanics with NAFLD were overrepresented (28% vs. 10%) and whites were underrepresented (45% vs. 59%). In conclusion, these racial and gender variations may reflect differences in genetic susceptibility to visceral adiposity, including hepatic involvement, and may have implications for the evaluation of persons with the metabolic syndrome. Clinicians need to be aware of the variable presentations of NAFLD in different racial and ethnic groups. (HEPATOLOGY 2005;41:372-379.)

Probable NAFLD, by ALT levels, and diabetes among Filipino-American Women

“…Probable NAFLD was associated with six-fold higher odds of diabetes. The prevalence of probable NAFLD observed in our women (17.2%) mirrored that of Hispanic women (15%) and was twice as high as Caucasian and African-American women (both 7%, respectively) in a U.S. national study [33]; our result was also similar to the prevalence in a study of Asian-Americans (16.7%) where NAFLD was defined by liver biopsy [34]. In fact, these Filipino women with probable NAFLD had mean ALT levels (48.7 U/L) consistent with those of Filipinas in the Philippines with NAFLD defined using ultrasound (47.7 U/L) [21].…”

Non-alcoholic Fatty Liver Disease: East Versus West

“…48,49 However, it has now been shown from a multiethnic study in the USA that in Asians, 79% of patients are male, compared with only 44% in Caucasians. 9 Our data also show that 70% of our patients are male, 53 which is similar to Japan where 61% of NAFLD patients are males. 19 Data from other Asian countries show that the prevalence of fatty liver was higher in males being 13.3% and 2.7%, respectively, in males and females in China, 52 and 21.6% and 11.2%, respectively, in Korea.…”

Racial disparity in liver disease: Biological, cultural, or socioeconomic factors

“…In a crosssectional study of 159 newly diagnosed NAFLD cases, there was a disproportionately high number of Hispanic patients with NAFLD (28%) relative to their composition in the regional general population (10%). 18 Conversely, whites (45%) and African Americans (3%) were underrepresented among the NAFLD cohort compared to their prevalence in the general population. Because factors such as type 2 diabetes mellitus and obesity are predisposing factors for the development of NAFLD, cultural factors such as diet and biological susceptibility may contribute to the higher relative prevalence of NAFLD in Hispanics.…”